Basic Principles in 23-, 25-, and 27-Gauge Pars Plana Vitrectomy

Although sutureless techniques for 20-gauge vitrectomy had previously been described, it was not until the advent of 25-gauge vitrectomy that transconjunctival sutureless vitrectomy became popular. The development of less invasive methods had been motivated by the desire to avoid typical complications of 20-gauge pars plana vitrectomy, spare the conjunctiva from scarring, and shorten procedural time. During the early stages of small gauge vitrectomy, the lack of stiffness and the limited range of the instruments provoked skepticism among retina specialists and dampened initial enthusiasm. However, ingenious design, improved materials and adaptation of operating techniques lately led to rapid progress and much improved performance of small gauge vitrectomy systems. In fact, some surgeons now use 27-gauge systems almost exclusively for nearly the entire spectrum of vitreoretinal pathology. This chapter discusses performance characteristics and limitations of some popular small gauge vitrectomy platforms. Handling techniques and tricks to avoid common complications specific to minimally invasive pars plana vitrectomy are explained.